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Everything in development, the medicines held by this cancer's subtypes, the open problems and what is being done about them, the roadmaps, and what changed on this record.
What is in development for Colorectal cancer, drawn from the whole corpus: 477 items. Drugs are grouped by the most advanced trial phase they have reached anywhere; approved treatments sit under standard of care. Technologies are the methods being tested for this cancer, trials are the studies recorded here, and ideas are proposals not yet in a trial.
4 medicines on record are linked to one of the types below rather than to Colorectal cancer itself. Grouped by the type that holds them; each list opens that type's own page.
Outcomes differ sharply by race, income and geography, and the gap survives adjustment for stage: five-year bowel cancer survival in England is 55 percent in the most deprived group against 62.9 percent in the least (Cancer Research UK), and emergency presentation, which carries the worst outlook, is concentrated in the same places.
Microsatellite-stable disease, 95% of metastatic colorectal cancer, has no working immunotherapy: the phase 3 test of atezolizumab with or without a MEK inhibitor matched regorafenib, and the best signal so far, botensilimab plus balstilimab, comes from single-arm cohorts (17% of 101 response-evaluable patients in the phase 1, Bullock 2024; 21% of 123 patients selected for the absence of liver metastases in the 2026 report). No randomised trial has yet selected patients by immune biology rather than by line of therapy.
Background: Circulating tumour DNA (ctDNA), Minimal / molecular residual disease (MRD), Oligometastatic disease, Organ tropism: seed and soil, Peritoneal metastasis. Also on OnCo: Atlas of advanced disease · How cancer spreads: the metastasis stages.
The consensus molecular subtypes were predictive of which biological drug works in the one randomised analysis of them, yet the mesenchymal class is largely a measurement of stroma rather than of cancer cells, no assay is approved, and no prospective subtype-directed trial has been run.
KRAS G12D, the commonest colorectal KRAS allele at about 29% of KRAS mutations, and G13D at about 18%, have no approved inhibitor; the only targeted allele, G12C, is about 3% of cases and needs an EGFR antibody alongside it.
Background: p53 / RB / cell-cycle checkpoint, RAS / RAF / MEK / ERK (MAPK). Also on OnCo: Targets · KRAS roadmap.
POLE-ultramutated tumours, 1% of cases and the most mutated in the disease, are invisible to the mismatch repair immunohistochemistry and MSI tests that every patient gets, so they are found only where sequencing is done.
Extended RAS testing is required before an EGFR antibody, yet an assay that reads only KRAS codons 12 and 13 still misses about one in six KRAS mutations and nearly all NRAS mutations, and the FDA companion diagnostic list still carries the old codon 12 and 13 definition for cetuximab beside the extended one for panitumumab, so two tumours called wild-type by two laboratories are not making the same claim.
Screening delivers the effect of its uptake, not of its test: 40.4 percent of the Nottingham screening group never returned a kit, and endoscopy capacity and the endoscopist's adenoma detection rate then decide what a positive test is worth.
Background: Faecal immunochemical test (FIT), Stage shift. Also on OnCo: Symptoms and red flags · Early detection roadmap.
Incidence in adults under 50 is rising by 1.6 to 7.9 percent a year across Europe and the United States, the stage shift screening bought is reversing (60 percent of United States cases advanced in 2019 against 52 percent in the mid-2000s), and the only mechanistic lead is a bacterial toxin signature enriched 3.3-fold in cancers diagnosed before 40.
Background: Faecal immunochemical test (FIT), Stage shift. Also on OnCo: Symptoms and red flags · Early detection roadmap.
Organ preservation for mismatch repair-proficient rectal cancer has never been randomised against surgery, and the bowel, urinary and sexual function that justifies it has never been a primary endpoint.
Circulating tumour DNA identifies who will relapse but has still not been shown to tell anyone what to do about it outside stage II colon cancer: DYNAMIC-III could not prove de-escalation non-inferior in stage III, its escalation arm gave no benefit, and ALTAIR's post-adjuvant trifluridine/tipiracil missed its endpoint while causing grade 3 or higher haematological toxicity in 73 percent. The negative result is not a safe one either: about one in ten circulating tumour DNA-negative stage II patients still recurs.
Background: Circulating tumour DNA (ctDNA), Minimal / molecular residual disease (MRD), Neoadjuvant / adjuvant / perioperative. Also on OnCo: Treatment journeys · Survivorship planner.
Peritoneal metastases have no systemic or regional treatment that adds to complete cytoreductive surgery: oxaliplatin HIPEC failed in PRODIGE 7 as treatment, in COLOPEC as prophylaxis and in PROPHYLOCHIP as second-look surgery, and no other intraperitoneal agent has randomised evidence.
Background: Circulating tumour DNA (ctDNA), Minimal / molecular residual disease (MRD), Oligometastatic disease, Organ tropism: seed and soil, Peritoneal metastasis. Also on OnCo: Atlas of advanced disease · How cancer spreads: the metastasis stages.
Why adding cetuximab around resection of colorectal liver metastases shortened median survival from 81.0 to 55.4 months in New EPOC has never been explained, and until it is, the safety of any targeted drug in a curative pathway rests on assumption rather than mechanism.
Background: Circulating tumour DNA (ctDNA), Minimal / molecular residual disease (MRD), Oligometastatic disease, Organ tropism: seed and soil, Peritoneal metastasis. Also on OnCo: Atlas of advanced disease · How cancer spreads: the metastasis stages.
The HER2 and KRAS G12C combinations approved in the United States on response rate alone have no confirmatory phase 3 result yet (MOUNTAINEER-03 completes December 2027, KRYSTAL-10 is closed but unreported, CodeBreaK 301 completes September 2028) and none is funded in England, so a patient's access to a biomarker-matched treatment now depends more on country than on biology.
Also on OnCo: Financial help · Coverage by country · Funding verdicts by country.
Palliative care in colorectal cancer, stents against stomas, medical management of inoperable obstruction, liver capsule pain, rests largely on small series and consensus rather than randomised evidence, even though obstruction is how a fifth of these cancers present.
The screening threshold is a rationing decision. England calls a screened person for colonoscopy at 120 micrograms of haemoglobin per gram of faeces and refers a symptomatic person at 10; the gap is set by colonoscopy capacity, not by biology, and modelling of the English pilot shows how many cancers and adenomas a lower threshold would find (Br J Cancer 2022).
Background: Faecal immunochemical test (FIT), Stage shift. Also on OnCo: Symptoms and red flags · Early detection roadmap.
Screening uptake carries the inequality. NordICC found only 42 percent of invited people attended, and the English programme's own standards set an acceptable uptake of 62 percent at ages 60 to 74 with no level yet agreed for the newly invited 50 to 59 group.
Background: Faecal immunochemical test (FIT), Stage shift. Also on OnCo: Symptoms and red flags · Early detection roadmap.
Serrated lesions are the ones that get missed. They cause about 30 percent of colorectal cancers, bleed rarely so faecal tests find few of them, and are flat and pale enough to be missed at colonoscopy; interval cancers concentrate here.
Quality of surgery and pathology still varies. The circumferential resection margin and the completeness of the mesorectal envelope are the strongest things a rectal cancer team controls, and both depend on reporting standards that are not applied everywhere.
Dated changes read from the records linked to this cancer: approvals, regulatory steps, reported trials, guideline versions and milestones. Newest first; no date is inferred.
On EdgeAll 252 changes by month →When this page itself was last checked or edited.
Full approval in first-line BRAF V600E mCRC with OS benefit
First- and second-line metastatic colorectal cancer with fluoropyrimidine-based chemotherapy, only when targeted treatment or immunotherapy is unsuitable
First-line BRAF V600E mCRC with cetuximab and chemotherapy
Metastatic colorectal cancer with a BRAF V600E mutation
Colorectal cancer screening in average-risk adults aged 45 and older